External ventricular drain infections: successful implementation of strategies to reduce infection rate

<p><b>INTRODUCTION</b>External ventricular drain (EVD) infections can cause serious complications. We performed an audit of EVD infections within our neurosurgical unit. Through this study, we aimed to reduce the incidence of external ventricular drain-related infection, including ventriculities in neurosurgical patients.</p><p><b>METHODS</b>We conducted an audit of the EVD infections in our institution observed over a one-and-a-half year period. This was conducted in three phases. A baseline EVD infection rate was determined for Phase I, from January to June 2007. We introduced the following measures to reduce EVD infection rate in Phase II, from July to December 2007: (1) For Neurosurgery doctors: performing proper surgical techniques to minimise intra-operative infections; educating junior doctors on proper CSF sampling from the EVD; and minimising the number of days the EVD is maintained in situ; (2) For Neurosurgery nurse clinicians: developing Standard Operating Procedures on nursing management of EVDs; conducting EVD care workshops for nurses working in neurosurgical wards; and competency skill checks on the management of EVDs for nurses working in the neurosurgical wards. Silver-coated EVDs were introduced in Phase III of the study from January to June 2008.</p><p><b>RESULTS</b>The EVD infection rate decreased from a baseline of 6.1% to 3.8% in Phase II; a further reduction from 3.8% to 0% was achieved during Phase III.</p><p><b>CONCLUSION</b>Good teamwork among doctors and nurses is essential for reducing EVD infection rate. We managed to reduce EVD infections substantially and would continue to strive to remain infection-free in the future.</p>

Migration of the Abdominal Catheter of a Ventriculoperitoneal Shunt into the Mouth: A Rare Presentation

A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies. The ventriculopleural (VPL) shunt inserted for hydrocephalus was complicated by pleural effusion, for which a ventriculoperitoneal (VP) shunt was inserted on the contralateral side. He subsequently presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract. The child also had a history of peritonitis post-exomphalos repair, which may have predisposed him to this relatively uncommon shunt complication. Probable causes and risk factors of the perforation are discussed.